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Asima Bajwa,1 Gitanjali Khurana,2 Donald Kimpel,2 Ashvini K Reddy1 1Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA; 2Division of Clinical Rheumatology, Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA Objective: The proportion of patients with systemic lupus erythematosus (SLE) who manifest retinal involvement increases many fold in patients with active systemic disease. The objective of this report is to stress upon the significance of comprehensive ophthalmic assessment of all SLE patients to prevent and manage blinding ocular manifestations of the disease. Methods: Retrospective case review. Results: Incidental retinal vascular complications seen in patients undergoing baseline hydroxychloroquine screening. Conclusion: The purpose of comprehensive ophthalmic screening in SLE patients is twofold. It will aid in the diagnosis and treatment of blinding ocular complications of the disease and monitor hydroxychloroquine macular toxicity. Keywords: systemic lupus erythematosus, hydroxychloroquine, retinal vein occlusion, retinal artery occlusion

The article focuses on speech delivered by U.S. President Donald Trump in Asia using the term "Indo-Pacific" instead of "Asia-Pacific," which has been used most often by previous American administrations. Topics discussed include rationale behind the term "Indo-Pacific" arose from economic and security developments; China's economic rise led to enhanced military power and assertiveness; and China's Belt and Road Initiative expected to contribute to economic integration of Indian Ocean region.

RFID is an automatic identification method consisting of several components such as tags, tag readers, edge servers, middleware, and application software. There are four main frequency bands for RFID tags commonly in use. They are categorized by their radio frequency: low frequency tags (125 or 134.2 kHz), high frequency tags (13.56 MHz), UHF tags (868 to 956 MHz), and microwave tags (2.45 GHz or 5.8 GHz). RFID tags can be either active, semi-passive (i.e. semi-active) or passive. In the field of Textile and Apparel the RFID is used in manufacturing, inventory control, warehousing, distribution, logistics, automatic object tracking, supply chain management etc. In the present paper, the studies of one of the most promising technological innovations in Information Technology i.e., Radio Frequency IDentification (RFID) is discussed. [ABSTRACT FROM AUTHOR]

Complex and amorphous threats confront India's security environment in its maritime East. India has very high stakes in the Bay of Bengal and its adjoining seas. The confluence of vital sea lines makes this region one of great strategic relevance to other powers as well. This translates into both challenges and opportunities for India. The Andaman & Nicobar archipelago had long been perceived as India's key vulnerability due to its remote location and a history of some of its islands 'slipping away' from the Indian dominion. Such wariness may be unfounded in the present times. Appropriate measures have been taken to strengthen its defence. The island chain can now play a greater role towards securing India's vital interests in the East beyond merely protecting itself. To achieve this, India needs to adopt a two-fold approach — first, augment its intrinsic capabilities, and second, actively engage its maritime neighbours. [ABSTRACT FROM AUTHOR]

Vancomycin is a bactericidal antibiotic. It is commonly used to treat Methicillin Resistant Staphylococcus Aureus (MRSA) infections. It is also used locally with Polymethyl methacrylate to treat chronic bone infections. Locally placed beads deliver high concentration of antibiotics locally with few adverse effects as compared to parenteral therapy. There are two complications mentioned on intravenous infusion of vancomycin namely anaphylactic reaction and red man syndrome; but there is no known literature on complications arising from vancomycin impregnated cement beads. We report a case of red man syndrome following usage of vancomycin impregnated cement beads which is not reported in any available orthopaedic literature. [ABSTRACT FROM AUTHOR]

Abstract Background This study documented elevated rates of emergency room (ER) visits for acute upper and lower respiratory infections and asthma-related conditions in the children of Quito, Ecuador associated with the eruption of Guagua Pichincha in April of 2000. Methods We abstracted 5169 (43% females) ER records with primary respiratory conditions treated from January 1 – December 27, 2000 and examined the change in pediatric ER visits for respiratory conditions before, during, and after exposure events of April, 2000. We applied a Poisson regression model adapted to time series of cases for three non-overlapping disease categories: acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), and asthma-related conditions in boys and girls for three age groups: 0–4, 5–9, and 10–15 years. Results At the main pediatric medical facility, the Baca Ortiz Pediatric Hospital, the rate of emergency room (ER) visits due to respiratory conditions substantially increased in the three weeks after eruption (RR = 2.22, 95%CI = [1.95, 2.52] and RR = 1.72 95%CI = [1.49, 1.97] for lower and upper respiratory tract infections respectively. The largest impact of eruptions on respiratory distress was observed in children younger than 5 years (RR = 2.21, 95%CI = [1.79, 2.73] and RR = 2.16 95%CI = [1.67, 2.76] in boys and girls respectively). The rate of asthma and asthma-related diagnosis doubled during the period of volcano fumarolic activity (RR = 1.97, 95%CI = [1.19, 3.24]). Overall, 28 days of volcanic activity and ash releases resulted in 345 (95%CI = [241, 460]) additional ER visits due to respiratory conditions. Conclusion The study has demonstrated strong relationship between ash exposure and respiratory effects in children.

Objectives: Large granular lymphocyte (LGL) leukemia is a rare hematologic malignancy characterized by clonal expansion of cytotoxic T-cells frequent somatic activating STAT3 mutations. Based on the disease overlap between LGL leukemia rheumatoid arthritis (RA)a putative role for CD8+ T-cells in RA we hypothesized that STAT3 mutations may be detected in RA patient CD8+ T-cells correlate with clinical characteristics., Methods: Blood samples, clinical parameters, and demographics were collected from 98 RA patients and 9 healthy controls (HCs). CD8+ cell DNA was isolated and analyzed via droplet digital (dd)PCR to detect STAT3 mutations common in LGL leukemia: Y640F, D661Y, and the S614 to G618 region. STAT3 data from 99 HCs from a public dataset supplemented our 9 HCs., Results: RA patients had significantly increased presence of STAT3 mutations compared to controls (Y640F p=0.0005, D661Y p=0.0005). The majority of these were low variant allele frequency (VAF) (0.008-0.05%) mutations detected in a higher proportion of the RA population (31/98 Y640F, 17/98 D661Y) vs. HCs (0/108 Y640F, 0/108 D661Y). In addition, 3/98 RA patients had a STAT3 mutation at a VAF >5% compared to 0/108 controls. Serological markers, RF and anti-CCP positivity, were more frequently positive in RA patients with STAT3 mutation relative to those without (88% vs 59% RF, p=0.047; 92% vs 58% anti-CCP, p=0.031, respectively)., Conclusions: STAT3 activating mutations were detected in RA patient CD8+ cells and associated with seropositivity. Thus, STAT3 activating mutations may play a role in disease pathogenesis in a subset of RA patients., Competing Interests: TL has received Scientific Advisory Board membership, consultancy fees, honoraria, and/or stock options from Keystone Nano, Flagship Labs 86, Dren Bio, Recludix Pharma, Kymera Therapeutics, and Prime Genomics. DF has received research funding, honoraria, and/or stock options from AstraZeneca, Dren Bio, Recludix Pharma, and Kymera Therapeutics. AR has received research funding, consultancy fees, and Honoria from AstraZeneca and MedGenome Labs. DK has served on the Aurinia Lupus Center Advisory Board, and Clinical Advisory Board for Landos Biopharma; and is a member of the Amgen Speaker’s Bureau. ED has also received grants from Pfizer and Bristol-Myers Squibb related to RA, personal fees from Celgene and Gilead outside of the submitted work and is a current employee of AstraZeneca. FA has received consulting fees and/or royalties from Celgene, Inova, Advise Connect Inspire, and Hillstar Bio, Inc. ED and FA are authors on licensed patent no. 8,975,033, entitled “Human autoantibodies specific for pad3 which are cross-reactive with pad4 and their use in the diagnosis and treatment of rheumatoid arthritis and related diseases”. There are no conflicts of interest with the work presented in this manuscript. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be constructed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Moosic, Olson, Freijat, Khalique, Hamele, Shemo, Boodoo, Baker, Khurana, Schmachtenberg, Duffy, Ratan, Darrah, Andrade, Jones, Olson, Feith, Kimpel and Loughran.)

Background Percutaneous nephrolithotomy (PCNL) is one of the most frequently used methods of treating large and/or complex kidney stones. Despite the growing interest in this area, there are relatively few papers that report studies of the changes in hemodynamics in the perioperative period and the potential factors that might influence the patient's condition. This aspect, however, has not been well described in the current literature, although fluctuations in blood pressure, temperature, and electrolyte balance during surgery may also lead to development of complications. Objectives In this study, variations in vital signs during surgery and between surgeries of 134 patients who underwent PCNL were analyzed in relation to other predisposing factors such as hypothermia and the need for blood transfusion. Methods Biochemical data such as systolic blood pressure (SBP) and diastolic blood pressure (DBP), temperature, hemoglobin (Hb), hematocrit (Hct), and serum sodium and potassium were assessed at admission, during PCNL, and at 24 hours after surgery in 134 patients. In this study logistic regression was used to assess the influence of factors such as age, BMI (body mass index), surgery duration, volume of irrigation fluid, number of tracts, estimated blood loss, hypothermia, and requirement of red blood cell transfusions. Results The mean arterial pressure declined during surgery as compared to the preoperative value, reaching a value of 97.34 during the operation. The monitored mean temperature of the patient during the perioperative period was therefore reduced, with a small increase towards the end of the surgery. In the plasma concentrations, there was a decrease compared to pre- and postoperative values, and there was also a decline in 48-hour Hb, Hct, and sodium values. The analysis identified the volume of irrigation fluid as a predictor of mild hypothermia risk. A longer surgery time along with more tracts and worse condition of the patient meant that the patient needed more blood transfusion. It was also noted that none of them influenced the amount of Hb that was lost. Conclusion Variability in the recorded ABCs (airway, breathing, and circulation) before and after PCNL procedures was normative. Despite hypothermia being associated with the volume of irrigation fluids used in surgeries, most of the transfusions were administered in patient-complicated operations and critical states. This suggested that there was potential in defining the modifiable factors that worsen clinically reported outcomes to assist in enhancing protocol., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research Committee Himalayan Institute of Medical Sciences issued approval SRHU/HIMS/RC/2020/03. Research Committee Himalayan Institute of Medical Sciences Swami Ram Nagar, P.O. Doiwala, Dehradun-248016 Chairman Dr. Sunil Saini Members Dr. Jayanti Semwal Dr. Taruna Sharma Dr. Nadia Shirazi Dr. Garima Mittal Dr. Deepa Singh Dr. Shaili Vyas Dr. Yogesh Saxena Dr. Rashmi Jindal Dr. Sagar Modi Dr. Vivek Kumar (Biosciences) Mr. Shubham Pandey Representative from Finance Deptt.-SRHU Co-opted Members Dr. Kathleen McKeehan -HCN Representative from -HSET Member Secretary Dr. Meenu Gupta LETTER OF APPROVAL - PUBLICATION Ref. No.: SRHU/HIMS/RC/2020/03 To, Guide:Dr. Gurjeet Khurana Professor Department of Anaesthesiology Himalayan Institute of Medical Sciences Swami Rama Himalayan University Date: 8/04/2020 The Research Committee reviewed your submission on 04th April 2020 and approves your application regarding communication of the following paper for publication: "Assessment of risk factors for perioperative complications in percutaneous nephrolithotomy." The Committee recommended that it should be communicated to a journal indexed in Medline, Pubmed Central, Citation index, Sciences Citation index. Expanded Embase, Scopus, Directory of Open access journals (DOAJ). You are advised to mention "Swami Rama Himalayan University" as your institutional affiliation and to formally acknowledge financial support from the University, if any. Once your article is published, please ensure to let us know, so that we can update University records. (Dr. Sunil Saini) Chairman, Research Committee, HIMS Copy to: Dean Faculty of Medicine Dean Research, SRHU Vice Principal- PG HOD, Anaesthesiology Dr. Nidhi Kumar-Co-Guide research@ srhu.edu.in . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kothiyal et al.)

Introduction: Hydatid disease is uncommon in Humans. It rarely affects the bones and joints (0.5-4%). Frequent sites of bony involvement are vertebrae, pelvic bones, upper end of long bones e.g. humerus, femur and tibia., Material and Methods: We report a case of 41-year old female with primary Hydatid cyst of the entire right femur. Patient complaint of severe pain and was non ambulatory since the last 2 months., Results: Here, single staged Total Right Femur Replacement was done under General Anaesthesia. Patient was discharged after 6 days of hospital stay in a stable condition where physical rehabilitation was initiated after day one of the surgery, progressing to aided walking, standing and active lower limb exercises., Conclusion: Involvement of the entire femur was a challenging case. There is no consensus/gold standard treatment of severe cases. Given the involvement of the entire Right Femur along with spillage in the neighbouring muscles, patient underwent Total Femur Replacement with Hip and Knee Replacement., Competing Interests: Conflict of interestThe authors disclose no conflict of interest in the study., (© Indian Orthopaedics Association 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Nitrous oxide has been an integral part of surgical anesthesia for many years in the developed world and is still used in developing countries such as India. The other main concerns in low-resource countries are the lack of an advanced anesthesia gas-scavenging system and modular surgical theatres. As a greenhouse gas that has been present in the atmosphere for more than 100 years and damages the ozone layer, nitrous oxide is three times worse than sevoflurane. Here, we conducted an observational study to quantify the annual nitrous oxide consumption and its environmental impact in terms of carbon dioxide equivalence in one of busiest tertiary health care and research centers in Northern India., Methods: Data related to nitrous oxide expenditure' from the operation theatre and manifold complex of our tertiary care hospital and research center from 2018 to 2021 were collected monthly and analyzed. The outcomes were extracted from our observational study, which was approved by our institutional ethics board (INT/IEC/2017/1372 Dated 25.11.2017) and registered prospectively under the Central Registry (CTRI/2018/07/014745 Dated 05.07.2018)., Results: The annual nitrous oxide consumption in our tertiary care hospital was 22,081.00, 22,904.00, 17,456.00, and 18,392.00 m 3 (cubic meters) in 2018, 2019, 2020, and 2021, respectively. This indicates that the environmental impact of nitrous oxide (in terms of CO 2 equivalents) from our hospital in 2018, 2019, 2020, and 2021 was 13,016.64, 13,287.82, 10,289.94, and 10,841.24 tons, respectively., Conclusion: This huge amount of nitrous oxide splurge is no longer a matter of laughter, and serious efforts should be made at every central and peripheral health center level to reduce it., Competing Interests: CONFLICT OF INTEREST: There is no conflict of interest., (Copyright © 2024 Journal of Dental Anesthesia and Pain Medicine.)

Objective: Surgery for esophageal cancer is associated with high mortality and morbidity, especially in low and middle-income countries. The recent enhanced recovery after surgery guidelines for esophagectomy (2018) which attempt to reduce complications and length of stay (LOS) have rarely been validated in these settings. This study aimed to analyse the effect of this protocol on short-term outcomes in our subset of patients., Methods: A retrospective review was conducted to investigate the outcomes of enhanced recovery protocol (ERP) compared to standard pre-protocol care (PP) in patients who underwent esophagectomy for cancer (31 in ERP vs 61 in PP group) at Cancer Research Institute, Uttarakhand, India. The main outcomes measured were 30-day mortality, morbidity and LOS. Risk assessment was stratified as per Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) systems while complications were classified as per the Clavien-Dindo scale., Results: Preoperative clinical characteristics were similar between groups. Though the predicted POSSUM mortality and morbidity were significantly higher in the ERP group (p = 0.007), 30-day morbidity (19.35% vs 42.62%, p = 0.027) as well as median LOS (12 vs 15 days, p < 0.001) was significantly lower in ERP group. The PP group reported 4 deaths within 30 days as compared to none in the ERP group (p = 0.296). Furthermore, the ERP group reported lower occurrence of pulmonary complications (6.4%vs24.6%,p = 0.046), hemodynamic instability (0%vs14.75%,p = 0.026) as well as need for prolonged postoperative ventilation (> 24 h; 0% vs 11.48%, p = 0.004). Both minor and major complications as assessed by the Clavien-Dindo scale were lower in the group ERP though these differences were not statistically significant (0.059)., Conclusions: Implementation of ERP improved short-term outcomes; hence can be strongly recommended in patients undergoing esophagectomy., (© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)

Droplet collision and subsequent spreading or wetting interactions with the solid substrate exhibit rich and interesting physics and are also important for various utilities. The fluid dynamics becomes more interesting and insightful when the wettability and geometry of the surface are tuned and altered. This study investigates the post-impact regimes of droplet impact on hydrophilic and superhydrophobic concave profile grooves (having dimensions comparable to that of the droplet). The post-collision hydrodynamics for such substrate-droplet system is three-dimensional, as in addition to droplet dynamics in the azimuthal direction, liquid jets may also be generated in the axial direction of the groove. Thereby the system may either lead to wetting or jetting, depending on the impact conditions. The effect of the impact Weber number (We) on the jet velocity, non-dimensional spreading width (γ) and non-dimensional south-pole film thickness (h * ) has been probed and quantified. The observations reveal that the role of the wettability of the substrate is more profound in the recoiling stage than in the spreading stage, because inertial forces dominate in the latter. It is also noted that the spreading width increases and south-pole height decreases with increasing the impact Weber number. The opposite trend is noted upon increasing the groove concavity by altering just one dimension of the groove. The jet velocity is found to be the highest immediately after the impact and eventually decreases in a nonlinear fashion. Further, it has been found that the jet velocity increases with increasing the impact Weber number and that this effect is more prominent for superhydrophobic surfaces. A semi-analytical framework has been proposed to predict the jet velocity evolution in terms of governing Weber (We) and capillary (Ca) numbers. The predictions of the proposed model are in good agreement with the experimental observations., (© 2023. The Author(s), under exclusive licence to EDP Sciences, SIF and Springer-Verlag GmbH Germany, part of Springer Nature.)

This article presents a new approximation of order four in exponential form for two-dimensional (2D) quasilinear partial differential equation (PDE) of elliptic form with solution domain being irrational. It is further extended for application to a system of quasilinear elliptic PDEs with Dirichlet boundary conditions (DBCs). The main highlights of the method framed in this article are as under:•It uses a 9-point stencil with unequal mesh to approach the solution. The error analysis is discussed to authenticate the order of convergence of the proposed numerical approximation.•Various validating problems, for instance the Burgers' equation, Poisson equation in cylindrical coordinates, Navier-Stokes (NS) equations in rectangular and cylindrical coordinates are solved using the proposed techniques to depict their stability. The proposed approximation produces solution free of oscillations for large values of Reynolds Number in the vicinity of a singularity.•The results of the proposed method are superior in comparison to the existing methods of [49] and [56]., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Competing Interests: There are no conflicts of interest.

Downscaling limitations and limited write/erase cycles in conventional charge-storage based non-volatile memories stimulate the development of emerging memory devices having enhanced performance. Resistive random-access memory (RRAM) devices are recognized as the next-generation memory devices for employment in artificial intelligence and neuromorphic computing, due to their smallest cell size, high write/erase speed and endurance. Unipolar and bipolar resistive switching characteristics in graphene oxide (GO) have been extensively studied in recent years, whereas the study of non-polar and complementary switching is scarce. Here we fabricated GO-based RRAM devices with gold nanoparticles (Au Nps). Diverse types of switching behavior are observed by changing the processing methods and device geometry. Tri-layer GO-based devices illustrated non-polar resistive switching, which is a combination of unipolar and bipolar switching. Five-layer GO-based devices depicted complementary resistive switching having the lowest current values ~12 µA; and this structure is capable of resolving the sneak path issue. Both devices show good retention and endurance performance. Au Nps in tri-layer devices assisted the conducting path, whereas in five-layer devices, Au Nps layer worked as common electrodes between co-joined cells. These GO-based devices with Au Nps comprising different configuration are vital for practical applications of emerging non-volatile resistive memories.

Sessile droplets seated on superhydrophobic surfaces are known to exhibit internal circulation patterns. The present article experimentally demonstrates and theoretically confirms, for the very first time, that the nature and velocity of the internal circulation in sessile droplets seated on superhydrophobic surfaces are strongly governed by the curvature of the surface and its directionality. Sessile droplets were rested on concave and convex superhydrophobic surfaces, and both with one curvature (cylindrical) and two curvatures (spherical) and varying droplet diameter to curve diameters were studied. Particle image velocimetry (PIV) was employed for flow visualization and quantification. It was observed that increasing convexity of the surface leads to deterioration in the velocity of advection within the droplet, whereas increasing concavity of the surface augments the velocity of circulation. A scaling model based on the effective curvature-modulated change in wettability has been put forward to predict the phenomenon, but it was found to be weak in deducing the circulation velocities. Consequently, potential flow theory is employed and the curvatures are approximated as equivalent wedges, with the rested droplet engulfing the wedge partly. Based on the curvature of the surface, the equivalent included wedge angle is deduced. Flow theory over wedged structures is employed to deduce the changes in the internal velocity in the presence of curved surfaces. The spatiotemporally averaged experimental velocities are found to conform to predictions from the proposed model, and good agreement between the theoretical predictions and experimental observations is achieved. The present findings may have strong implications in thermofluidic transport phenomena or multiphase transport processes at the interfacial and/or microscale.

Background: Etomidate is a potent intravenous inducing agent with known undesirable side effects such as myoclonus and pain on injection in nonpremedicated patients., Aims: The aim of this study is to compare the effect of fentanyl and nalbuphine in the prevention of etomidate-induced myoclonus., Settings and Design: Randomized double-blind, placebo-controlled, and prospective comparative study., Materials and Methods: A total of 120 patients were randomly allocated to one of the three groups containing 40 patients each for intravenous administration of fentanyl 2 μg/kg diluted in 10 mL normal saline (NS) (Group 1), nalbuphine 0.3 mg/kg diluted in 10 mL NS (Group 2), and only 10 mL NS (Group 3) over 10 min. All groups subsequently received 0.3 mg/kg etomidate by intravenous bolus injection over 15-20 s and were assessed for the severity of pain using Grade IV pain scale and observed for myoclonus for 2 min and graded according to clinical severity. Serum creatinine phosphokinase (CPK) levels were obtained prior and postetomidate injection., Statistical Analysis: Statistical analysis was performed by the SPSS program version 17.0 for Windows. Tests used are Shaipro-Wilk test, ANOVA, Tukey's multiple comparison test, Tamhane's T2, and the Chi-square test. For all statistical tests, P < 0.05 was considered statistically significant with 5% level of significance (α)., Results: The incidence of myoclonus in Group 1 and 2 was 52.5% and 17.5%, respectively, whereas it was 92.45% in Group 3. There was no pain observed in 70%, 92.5%, and 50% of patients in Group 1, 2, and 3, respectively. There was a statistically significant difference in mean CPK level after induction among three groups ( P < 0.001)., Conclusion: Nalbuphine is more effective than fentanyl in the prevention of etomidate-induced myoclonus and pain with the minimum rise in CPK levels., Competing Interests: There are no conflicts of interest.

Context: Exposure to medications (prescribed or over-the-counter) or exposure to chemicals (unintentional or occupational) during pregnancy have always been of great scientific concerns., Aims: This study aims to ascertain whether the recently documented offspring sex ratio (OSR) skew in medical literature is reproducible among our respondent population and how our respondents' characteristics relate to the OSR skew (if any) in our respondent population., Settings and Design: A survey questionnaire uploaded on the SurveyMonkey ® Online Portal., Subjects and Methods: The survey was completed by the Indian anesthesiologists about themselves and their spouses during the periconceptional periods of their offspring., Statistical Analysis Used: Analysis of variance for means and Chi-square test for proportions with P < 0.05 as statistically significant., Results: Respondents (irrespective of gender) who sired first-born or second-born male children were anyway more likely to sire male children as reflected in the personal sex ratios among all offspring sired by them, and similarly respondents (irrespective of gender) who sired first-born or second-born female children were anyway more likely to sire female children. Male parents were significantly more common to have worked in operating rooms around the time of conception of first-born or second-born children. As compared to female anesthesiologists, male anesthesiologists significantly reported that they were practicing inhalational induction of anesthesia more often around the conception of their second-born female children as compared to around the conception of their second-born male children., Conclusions: Practice of inhalational induction of anesthesia was reportedly more common among Indian male anesthesiologists during periconceptional period of their second-born female children., Competing Interests: There are no conflicts of interest.

Aim: To compare the role of single intravenous (IV) bolus of lignocaine and dexamethasone on pain score and quality of recovery score (QoR40) after laparoscopic cholecystectomy., Setting and Design: The study was conducted at the postoperative recovery area, This was a double-blind randomized controlled study., Materials and Methods: Seventy patients 18-60 years of age, American Society of Anesthesiologists physical status Class I and II, who underwent elective laparoscopic cholecystectomy, were enrolled in this study after approval from the Institutional Ethics Committee. Patients were randomly allocated to two groups. Group 1 received: 2 mg/kg lignocaine diluted to 10 ml with normal saline, and Group 2 received 0.1 mg/kg IV dexamethasone diluted to 10 ml with normal saline. Global QoR-40 is a 40-item questionnaire that provides a global score and subscores across five dimensions: psychological support, comfort, independence, pain, and emotions. It was assessed on a preoperative day as baseline to assess patient's basic quality of life and at 24 h postoperative. Visual analog scale (VAS) static and dynamic, total analgesic consumption in a day, nausea and vomiting, and antiemetic per day were assessed., Statistical Analysis Used: Student's t -test, Chi-square test, Fisher's exact, Levene's test were used for statistical analysis., Results: Dexamethasone group had higher Global QoR-40 than lignocaine group 187.94 versus 182.85. Among dimensions of QoR-40, dexamethasone had statistically better physical comfort, physical independence, and pain relief as compared to lignocaine. Dexamethasone group had lower VAS compared to lignocaine group. Similarly, there was less fentanyl consumption in dexamethasone group (364.08 ± 127.31) in the postoperative period when compared to the lignocaine group (412.31 ± 147.8)., Conclusions: Preoperative administration of a single dose of dexamethasone enhanced QoR after laparoscopic cholecystectomy as compared to lignocaine bolus dose., Competing Interests: There are no conflicts of interest.

Background and Aims: Very few studies have compared continuous wound infiltration (CWI), continuous epidural infusion (CEI) and intravenous Patient Controlled Analgesia (PCA) with morphine in spine surgery. This study compared these modalities in patients undergoing microdissectomy., Methods: This prospective, randomized control trial was conducted on 75 patients of American Society of Anesthesiologists' physical status I or II undergoing microdiscectomy. Patients in all the three groups received morphine 1 mg IV, with a lockout period of 10 min after each bolus, and the maximum allowed dose was 15 mg/5 h postoperatively. Patients in Group A received CWI with 0.25% levobupivacaine 20 mL as bolus after extubation followed by infusion at 5 mL/h. Group B received CEI with 0.25% levobupivacaine at 5 mL/h. Patients in Group C received intravenous (IV) morphine by PCA pump only. The primary end points were static and dynamic visual analogue scores (VAS) and postoperative pain scores. Secondary observations were postoperative morphine consumption at 8 h, 24 h and 48 h, and patient satisfaction., Results: Group A showed greater analgesic effects at 12 h ( P < 0.02), 24 h ( P < 0.03), 36 h ( P < 0.008) and 48 h ( P < 0.007) when compared to the other two techniques, as pain scores were less in group A as compared to group B and C. The requirement of postoperative intravenous morphine (mg) was 18 ± 12.82, 22.92 ± 9.88, 41.56 ± 8.83 for groups A, B and C after 48 h ( P < 0.001)., Conclusion: Continuous wound infiltration is an effective postoperative pain control technique with minimal side effects, after spinal surgery., Competing Interests: There are no conflicts of interest.

Study Design: Prospective, observational, analytical, randomized control trial., Objective: To compare cervical spine movement for best laryngoscopic view and ease of intubation using Truview or McCoy laryngoscope in anticipated difficult intubation., Summary of Background Data: The addition of modified laryngoscope blade to the anesthesiologist's armamentarium adds flexibility and improves the skill of the anesthetist, which benefits the patients., Methods: One hundred patients of American Society of Anesthesiologists status I and II with predicted difficult intubation score ≥5 were divided into two groups: Group A (n = 50): intubation done with McCoy laryngoscope and Group B (n = 50): intubation done with Truview laryngoscope and compared for the ease of intubation using intubation difficulty scale (IDS), cervical spine movement, and hemodynamic alterations., Results: The total IDS determining the ease of tracheal intubation was better in Group B than Group A. On comparing the variables of IDS score, there was no difference between the two groups except 14 (28%) patients in Group A required application of external laryngeal pressure, whereas only five (10%) patients had this difficulty in Group B. It was seen that craniocervical extension was significantly less (2.5 times) in Group B as compared to Group A., Conclusion: In anticipated difficult intubation, Truview improves the laryngeal view, causes less movement at cervical spine, which could be more helpful in patients with restricted neck mobility, and has lesser complications., Level of Evidence: 2.

Background and Aims: The scenario in medical education is changing with objective structured clinical examination (OSCE) being introduced as an assessment tool. Its successful implementation in anaesthesiology postgraduate evaluation process is still limited. We decided to to evaluate the effectiveness of OSCE and compare it to conventional examinations as formative assessment tools in anaesthesiology., Methods: We conducted a cross-sectional comparative study in defined population of anaesthesiology postgraduate students to evaluate the effectiveness of OSCE as compared to conventional examination as formative assessment tool in anaesthesiology. Thirty-five students appeared for the conventional examination on the 1(st) day and viva voce on the 2(nd) day and OSCE on the last day. At the conclusion of the assessment, all the students were asked to respond to the perception evaluation questionnaire. We analysed the perception of OSCE among the students., Results: Results showed a positive perception of the objective structured physical examination (OSCE) as well as structured 9 (25.7%), fair 19 (54.2%) and unbiased 13 (37.1%) with more standardised scoring 9 (25.7%). The students perceived OSCE to be less stressful than other examination. Thirty-one (88.5%) students agreed that OSCE is easier to pass than conventional method and 29 (82.5%) commented that the degree of emotional stress is less in OSCE than traditional methods., Conclusion: OSCE is better evaluation tool when compared to conventional examination.

Forming-free resistive random access memory (ReRAM) devices having low switching voltages are a prerequisite for their commercial applications. In this study, the forming-free resistive switching characteristics of graphene oxide (GO) films embedded with gold nanoparticles (Au Nps), having an enhanced on/off ratio at very low switching voltages, were investigated for non-volatile memories. The GOAu films were deposited by the electrophoresis method and as-grown films were found to be in the low resistance state; therefore no forming voltage was required to activate the devices for switching. The devices having an enlarged on/off ratio window of ∼10(6) between two resistance states at low voltages (<1 V) for repetitive dc voltage sweeps showed excellent properties of endurance and retention. In these films Au Nps were uniformly dispersed over a large area that provided charge traps, which resulted in improved switching characteristics. Capacitance was also found to increase by a factor of ∼10, when comparing high and low resistance states in GOAu and pristine GO devices. Charge trapping and de-trapping by Au Nps was the mechanism responsible for the improved switching characteristics in the films.

As states take more steps to connect patients' gun ownership to their mental health, psychiatrists are being asked to provide mental health information after clinical interviews as well as after confiscation. This move into the patient-physician relationship raises new questions about how psychiatrists should obtain informed consent when interviews may result in reports to legal authorities. Consent warnings are already practiced more in the breach than in the observance and informed consent is imperfect at its best. In communities torn by controversies surrounding gun control, vehement political views will further influence these established themes to result in unprecedented pressures on patient confidentiality. This analysis draws on new movements in ethical theory and behavioral medicine that go beyond balancing principles to question the use of psychiatry in firearm reporting, and support a vigorous practice of informed consent to protect both individuals and the communities they live in., (Copyright © 2015 John Wiley & Sons, Ltd.)

Study Design: Prospective, double-blind study, randomized control trial., Objective: To evaluate and compare the analgesic efficacy, adverse effects, and clinical utility of gabapentin and pregabalin in postoperative pain management, long-term functional outcome, and quality of life in patients undergoing spinal surgery., Summary of Background Data: Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. The most common persistent symptoms are pain, motor deficit, and decreased functional status., Methods: This study was conducted in 90 patients belonging to the 18 to 75 age group of either sex undergoing spinal surgery under general anesthesia. Group A received 300 mg of gabapentin, group B received 75 mg of pregabalin, whereas group C received placebo 1 dose 1 hour before surgery and 8 hourly for 7 days, thereafter. The outcome of postoperative static and dynamic pain and functional outcome was recorded using 3 questionnaires-visual analogue scale, Prolo functional and economic score, Oswestry Disability Index score from preoperative period to 3 months postoperatively., Results: Among the 3 groups, subjects receiving pregabalin showed consistently reduced static and dynamic pain intensity and also required lesser amount of rescue drug throughout the postoperative period. There was statistically significant difference (P < 0.05) in the Prolo score and Oswestry Disability Index score at all time intervals between group B and group C. Although, significant difference in the functional outcome between group A and group B was seen at 3 months., Conclusion: Preoperative pregabalin administration is associated with less pain intensity and improved functional outcomes 3 months after lumbar discectomy followed by gabapentin and then placebo., Level of Evidence: 2.

Background: The incidence of pain reported in literature after IV administration of rocuronium is 50-80%. The aim of our study was to determine whether pre-treatment with intravenous granisetron and nitroglycerine would reduce rocuronium-induced pain., Methods: One hundred fifty patients of either sex, aged 18-65 years, American society of Anaesthesiologist grading (ASA) I-II, scheduled for various surgeries under general anesthesia were randomly assigned to one of the groups. Group G: received 2 granisetron (1mg/ml) diluted with 3 ml of 0.9% normal saline) while the Group C: received 5 ml of 0.9% normal saline. Group N: received 200΅g of nitroglycerine diluted to a total of 5 ml(with 0.9% normal saline). It was accompanied by manual venous occlusion for 20 seconds. Then 0.06mg/kg of rocuronium was injected through same cannula over 10-15 sec. Patients were asked by a blinded investigator to score the pain on injection of rocuronium using visual analogue scale (0-10) with 0-no pain,1-3 mild pain, 4-6 moderate and >=7 severe pain. At the same time discomfort in the form of patient's movement, such as no movement (grade 0), movement only wrist (grade 1), movement to the upper arm and shoulder of injected arm (grade 2) or generalized movements (grade3) was observed. Statistical analysis using independent t test, Mann-Whitney test and reverse ANOVA was done., Results: 1. At 0 seconds, in group G number of patients who experienced withdrawl score of 0-1 were 92%,group N were 82% while only 26% of patients in group C had favourable withdrawl score.74% of patients in group C had score of 2-3 at same time. 2. At 0 sec, in group G number of patients who experienced VAS score of 0-3 were 96%, group N 72%. At same time Group C 48 % of patients had VAS score of 2-3., Conclusion: We conclude that pre-treatment with granisetron or nitroglycerine both are highly effective in attenuation of rocuronium induced pain.

Context: Anaesthesia during cleft lip and palate surgery carries a high risk and difficult airway management in children., Aim: to study the perioperative anesthetic complications in poor children with cleft abnormalities., Settings and Design: Retrospective analysis., Materials and Methods: This retrospective audit was conducted on 2917 patients of smile train project under going general anesthesia for cleft lip and palate from January 2007 to December 2010. Demographic, pre-anesthetic status, anesthetic management and anesthesia complications were recorded. Chi-square test was used to assess the relation between patient factors and occurrence of complications., Results: Of the 3044, we were able to procure complete data of 2917 patients. Most of children presented with anemia 251 (35%), 202 (29%) had eosinophilia while 184 (26%) had upper respiratory tract infection. The incidence of perioperative complications was 8.19% of which 33.7% critical incidents occurred during the induction time. The most common complication was laryngospasm 77 (40.9%) followed by difficult intubation 64 (30.9%). There was no mortality., Conclusion: Since these procedures do not characterize an emergency, most of the perioperative complications can be prevented by following the routine installed by the institute and smile train protocols.